Lest it be thought that the American Army was dependent in any way for its hospital facilities and surgical supplies upon private contributions, it may be said that the Government during the period between April 6, 1917, and November 11, 1918, placed contracts for medical supplies amounting to $424,761,031. Contract cancellations after the armistice was signed amounted to $56,000,000. The remaining $370,000,000 approximately represents the cost to the United States of medicine, surgical instruments and dressings, ambulances, hospital furniture, equipment and supplies, and dental and veterinary supplies for the war.
This was considerably more money than was contributed by the American people to the American Red Cross, a great part of whose funds went to the relief of civilian populations in Europe, or to any other war charity. Thus it will be seen that the Government with billions of dollars to spend could well afford the few hundreds of millions necessary to give the American soldiers who needed it the best possible hospital attention. It accepted the gifts of this sort, ranging from gauze bandages to fully equipped motor ambulances, as the offerings of the people whose hearts overflowed with love and gratitude to the American soldiers and took this means of showing their concern; but the Government in no sense was dependent upon these donations.
Before 1914 four-fifths of all surgical instruments used in the United States were imported from Germany. This country, too, was practically dependent upon Germany for many of its most important medicines, including the potassium salts and such drugs as digitalin, salvarsan, atropin, etc. While in a way we had been developing substitute sources of supply in the United States for these indispensable commodities in the months between the outbreak of the great war and the date of our participation in it, the raising of a vast army and the project to send this army to the bloody battle fields of France created an American demand for medicines and surgical instruments beyond anything ever known in the United States. Yet, through the cooperation of manufacturers and the officers of the Medical Department's general purchasing office, which was on November 15, 1918, incorporated in the office of the Director of Purchase and Storage, sufficient supplies were developed, not only of medicine but of surgical instruments.
The development of the production of medicines for the use of troops in the field was particularly notable. The important drug, salvarsan, used in the treatment of syphilis, was a patented formula and had been furnished formerly by a single German manufacturer. In this country we produced arsphenamine as a substitute, gradually increasing the supply and constantly improving the drug until at length its toxicity had been so reduced that it equaled or even excelled the German product.
The facilities of the American drug and tablet manufacturers were taxed to the utmost to supply the Army. For example, during the year 1918 a total of 46,000,000 quinine tablets was produced, while 172,000,000 aspirin tablets were manufactured during the same period, and 835,000 pounds of calomel ointment, 45,000,000 iodine swabs, 10,250,000 tins of foot powder, and 300,000,000 tubes of iodine-potassium. All other items of medicines, antiseptics, and disinfectants, required by the Medical Department, were increased in proportion. This production not only strained the facilities of the manufacturers of chemicals and drugs but also called upon the glassware manufacturers for the necessary bottles and tubes in which to pack these medicines satisfactorily. Here again was an effort that required close cooperation between the trade and the Medical Department in order to meet the demand.
When it became evident that a declaration of war against Germany was imminent, the Medical Department proceeded to analyze the country's resources of medical supplies. These resources were to a large extent limited. The Allied nations had been making heavy and constant demands for these materials, so much so that even the mobilization of such a relatively small number of troops as were centered along the Mexican Border put a severe burden upon the medical supply facilities of the country.
The Council of National Defense took up the medical supplies problem at the outset. The various manufacturers sent their representatives to consult with the Surgeon General, and committees on surgical instruments, surgical dressings, medicines, and other important supplies were formed. These committees allocated among the various manufacturers the first emergency orders for these materials. The result was that the base hospitals at the 32 mobilization camps in 1917 were equipped in an amazingly short time. The New York Medical Supply Depot, which was then the largest purchasing agent, was called upon to supply 500 hospital beds each to 22 of the camps. This work was handled so rapidly that in some cases the shipments had to be held back to wait for the completion of the hospital buildings.
Perhaps the most difficult task was to determine what quantities of medical supplies would be needed for a given period. It is a comparatively simple matter to estimate the quantity of clothing necessary for a certain number of troops, or to figure what food they will require; but it is not possible to forecast the number of men who will be sick at a given camp at a specified time, nor is it possible to foretell the nature of diseases or injuries. An epidemic of measles or mumps requires different treatment than an epidemic of influenza, and makes necessary the use of a different variety of medical supplies. Experience sheets of supplies actually used in the past formed the basis of our requirements schedules.
Eventually there was worked out a system of supply based on the initial requirements of the unit of 25,000 men in the Expeditionary Forces and the automatic supply of replenishment of this equipment. In this system use was made of the knowledge and experience obtained by the British and French medical forces during their nearly three years of warfare before America went in.
The following statement of estimated expenditures for the fiscal year 1920 illustrates the difference in the medical requirements of an army of 500,000 men under peace conditions and an army of 5,000,000 men in a war such as the recent one:
Civilian experts in various lines of medical supplies were brought into the organization to supply the wide range of specialized knowledge required in such a universal buying program as the Medical Department was about to conduct. Before the war the Army's purchases of instruments for oral and brain surgery, orthopedic supplies, Dakin outfits, and other special apparatus were practically negligible. During the war period these purchases amounted to millions of dollars. It may be seen readily that the purchasing office had to possess more than a superficial understanding of the materials to be bought.
Orders customarily went to the lowest bidders, with a careful review in Washington of all prices named in contracts. The inspection of material was an important phase of the work. This inspection was handled through the New York Medical Supply Depot, whichcalled in as assistants the United States Board of Customs Appraisers at New York City. That corps of men had had long years of experience in inspecting and determining the value of surgical supplies, as most of these supplies in the past had come through the customhouse from foreign countries. The inspection of drugs was handled by the Medical Department's laboratories, the Army Medical School, and by the Bureau of Standards, which rendered valuable assistance in examining and testing samples. In addition the Medical Department maintained a corps of inspectors to travel from one factory to another, keeping in close touch with the progress and assisting in procuring raw materials and expediting deliveries.
The medical supplies were divided under the following classifications:
The New York depot was intrusted with the purchase of miscellaneous hospital equipment and dental and X-ray supplies. The St. Louis depot purchased the veterinary supplies, and the field medical supply depot at Washington purchased the laboratory and field supplies. The motor ambulance supply depot, established at Louisville, Ky., purchased ambulances and ambulance spare parts. Appreciating the necessity for a certain amount of cooperation where the purchase of conflicting articles by the various depots was concerned, the general purchasing office of the Medical Department was organized at Washington. This purchasing office bought all surgical dressings, surgical instruments, and medicines and such items as were used in the field, post, veterinary, and dental stations.
In connection with the production of surgical instruments in this country it was necessary for the Medical Department to educate in the manufacture of these instruments certain concerns which had been engaged in the production of similar devices. Men skilled in the manufacture of instruments, with long years of experience, were sent to these factories to work out with the forces there satisfactory processes. It was necessary to recruit toolmakers, jewelers, and cutlery manufacturers in order to build up a sufficient supply of forged and finished instruments.
Surgical needles, for instance, had never been made in this country, but had all been obtained in England. As a war measure the BritishGovernment placed this item on its list of restricted exports. After long and continued effort the general purchasing office developed American sources of supply of needles with remarkable success.
In one month we shipped 65 tons of surgical instruments to France. A few of the principal instruments, quantities purchased, and the prices paid were as follows:
Each general operating case contains more than 50 instruments and the small operating case more than 30 instruments, and in these two items alone are more than 207,000 forgings, practically all handwork.
The quantity of surgical dressings used in peace times was relatively small, so that the sources for supplying this material had to be increased enormously. To do this the Government went out into the cotton goods industry and induced such concerns as curtain makers and manufacturers of waists and white goods to make bandages for surgical uses. The Government obtained the raw material, gray gauze, and turned it over to the various manufacturers for bleaching, cutting, sterilizing, and packing in the necessary cartons.
Among other items during the last year of the war a total of 12,000,000 individual dressing packets were purchased and 795,000 boxes of gauze bandages, 574,400,000 yards of bandage, 10,000,000 first-aid packets, and 108,000,000 yards of gauze. During the same period a total quantity of 3,814,000 pounds of absorbent cotton was also bought.
Among the miscellaneous items obtained were approximately 1,600,000 blankets, 258,000 litters, and over 1,000,000 clinical thermometers. The rate of output of clinical thermometers was not all that the Medical Department thought it should be, and as a result a large quantity of thermometers was obtained on mandatory orders.
The heaviest buying period during the war was between July 1 and November 30, 1918. The supplies purchased or ordered in that period were the following, with their costs:
It is interesting to note that the purchases made in France for the Medical Department consisted mostly of large and bulky items, mainly hospital furniture and equipment, which, if transported from the United States, would necessitate the use of considerable valuable cargo space. Foreign purchases were made primarily to save ship space and not because of any shortage or failure to function in this country.
Although America is famous throughout the world for her dentists and dentistry, yet the participation of this country in the war created a demand for dental supplies that the American manufacturing facilities in existence in 1917 were unable to fill. For that reason it was necessary to extend the production capacity. The manufacturers in the trade rose to the occasion, and as a result the Government was able to supply to the A. E. F. from the United States all dental materials required, the only purchases made in France being of exceedingly bulky apparatus.
The total amount allotted for dental supplies for an army of 5,000,000 men in 1919 was $6,256,482. During the five months between July 1 and November 30, 1918, the dental purchases amounted to approximately $5,000,000.
The six leading dental items purchased by the Medical Department and the quantity and cost of each were as follows: